Healthcare Provider Details

I. General information

NPI: 1760931026
Provider Name (Legal Business Name): THREE OAKS HEALTH S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 VILLAGE WALK LN STE F
JOHNSON CREEK WI
53038-9540
US

IV. Provider business mailing address

480 VILLAGE WALK LN STE F
JOHNSON CREEK WI
53038-9540
US

V. Phone/Fax

Practice location:
  • Phone: 920-542-3010
  • Fax:
Mailing address:
  • Phone: 920-542-3010
  • Fax: 920-699-9699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES MILFORD
Title or Position: PROVIDER
Credential: M.D.
Phone: 262-337-1068